Provider Demographics
NPI:1720256712
Name:CROWELL, LORA BROWN (RN)
Entity Type:Individual
Prefix:MS
First Name:LORA
Middle Name:BROWN
Last Name:CROWELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 SCHOOL HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:HEDGESVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25427-7220
Mailing Address - Country:US
Mailing Address - Phone:304-754-3313
Mailing Address - Fax:304-754-6613
Practice Address - Street 1:BERKELEY COUNTY BOARD OF EDUCATION
Practice Address - Street 2:401 SOUTH QUEEN STREET
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401
Practice Address - Country:US
Practice Address - Phone:304-267-3500
Practice Address - Fax:304-267-3524
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV28083163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810005074Medicaid